Today while working my shift in the emergency room, an old lady was brought in very sick and in fact near death. I did my usual workup and evaluation and attempted to administer life saving treatment. It was my plan to admit this woman to the hospital. I found out a little later that this same woman had been a patient here just slightly more than 2 weeks ago with a DIFFERENT DIAGNOSIS. I was told that if this woman was admitted, the hospital would not be paid.
The new Medicare rule now is that if the same Medicare patient is re-admitted to the hospital within 30 days, the hospital will not be paid. When they first started this nonsense they said this only applied to patients with the same diagnosis. Now they have "expanded" the rule to include re-admissions for any reason. So if you're in the hospital for pneumonia, and 3 weeks later, you break your leg.......too bad. Medicare will not pay the hospital to fix your leg.
A little later a man was brought in by ambulance, very sick, in pain, and near death. I did my usual evaluation and treatment, doing my best to ease pain and stabilize this man's illness. He needed to be admitted. To my chagrin I found out that he had been treated for the SAME problem at a DIFFERENT HOSPITAL about 10 days prior. If I admitted this man, our hospital would be paid nothing. I admitted the man.
My friends I am caught in a terrible position. I could have given treatment to both of these people and sent them out. There is no doubt that both of them would have died. Oh, I could also be sued for malpractice, but nobody cares about that. That's why we have insurance, right?
My other choice is to admit the person, knowing full well that the hospital will have to absorb the cost of care without hope of remuneration.
This is the climate we as healthcare providers find ourselves in today. How many small and struggling hospitals will survive under such ludicrous payment schemes? Indeed many facilities will close their doors. Many doctors will retire early or simply go do something else. As more and more are added to the Obamacare rolls, there will be less and less access. People will get sicker and yes, people will die because of it.
I had a sick and sinking feeling in the pit of my stomach today after both of these incidents. We have a good hospital. Our nurses, technicians, and support staff work very hard and they deserve to be paid for their efforts. I am not so worried about myself as I am near retirement, but I worry for all the younger folks in the healthcare business and I worry about our seniors who are in the long run going to be sacrificed as the government implements cost cutting shenanigans to cover up their broken promise made way back in 1964.
Folks, this is a nightmare!